经外侧裂入路行基底节区高血压脑出血手术的解剖和技巧

Microanatomy concerning with operation approach in lateral fissure of cerebrum region for hypertensive cerebral hemorrhage of basal ganglia region

目的:为经外侧裂行基底节区高血压手术提供显微外科解剖学基础和手术技巧。方法:15例头颅湿标本,模拟手术入路观察外侧裂区解剖结构和相互毗邻关系并进行手术入路研究。结果:视辐射分前、中、后3束,前束覆盖颞角前尖端顶壁和侧壁,中束在颞角上壁和侧壁,前束和后束从外侧膝状体发出后向前卷曲,而后束离开外侧膝状体后终止于距状沟上岸没有向前的卷曲,后束走行于侧脑室下角的外侧壁,这样视辐射纤维存在于脑侧面的颞角的顶壁和中后及侧壁,颞角下壁没有视辐射纤维;经外侧裂、梨状皮质和钩的入路行基底节区高血压手术时,可以不损伤视辐射和钩束。结论:手术入路经外侧裂通过钩前面和上面的梨状皮质能安全进入基底节区而不损伤视辐射和钩束的主要部分。

Objective： To provide anatomic basis for operation approach and technique in lateral fissure of cerebrum region. Methods： This study was based on 15 wet cadaver head specimens, which were studied the structures and relationships of lateral fissure of cerebrum region. Results： The optic radiation can be subdivided into three bundles （anterior, middle, and posterior）. The anterior bundle covered the roof and lateral wall of the temporal horn, the middle bundle was found on the superior and lateral wall of the temporal horn, the anterior and middle bundles curved to the anterior temporal horn after originating from the lateral geniculate body, the posterior bundle was found on the lateral wall of the inferior horn of the lateral ventricle, which left the lateral geniculate body to end at the upper bank of the calcarine fissure without forming anterior curve. A tmnssylvian approach was performed in basal ganglia region for hypertensive cerebral hemorrhage without injuring the optic radiation and the uncinate fasciculus. Conclusions： An anteromedial transsylvian approach through the pyriform cortex at the level of the anterior and superior surface of the uncus enables a safe entry into the basal ganglia region without injury to the optic radiation fibers or the main part of the uncinate fasciulus.